EMPLOYMENT APPLICATION FORM Date Full Name First Middle Last Street Address Street Address City State ZIP Phone NumberType of SchoolName of SchoolLocation City & StateDates AttendedOverall Grade AverageDiploma Or DegreeMajor Field or Course of study Type of SchoolName of SchoolLocation City & StateDates AttendedOverall Grade AverageDiploma Or DegreeMajor Field or Course of study Type of SchoolName of SchoolLocation City & StateDates AttendedOverall Grade AverageDiploma Or DegreeMajor Field or Course of study Type of SchoolName of SchoolLocation City & StateDates AttendedOverall Grade AverageDiploma Or DegreeMajor Field or Course of study Subjects Liked BestWhy?Subjects Liked LeastWhy?Scholarships ReceivedScholastic or Other HonorsExtracurricular ActivitiesDo you plan to continue your education?YesNoIf so when and in what fieldCollege Expenses Earned (%)How were they earned?SKILLS:ComputersSoftwareTyping SpeedCalculatorPhonesOtherPlease List in chronological order, giving present or last position firstDo not include military servicePresent or last employer(Students state last summer job)Name of FirmPosition TitlePhone NumberAddressImmediate SupervisorNature of DutiesStarting Salary ($)Last Salary ($)Start DateEnd DateReason for LeavingPreviously employed byName of FirmPosition TitlePhone NumberAddressImmediate SupervisorNature of DutiesStarting Salary ($)Last Salary ($)Start DateEnd DateReason for LeavingPreviously Employed ByName of FirmPosition TitlePhone NumberAddressImmediate SupervisorNature of DutiesStarting Salary ($)Last Salary ($)Start DateEnd DateReason for LeavingHave you ever served in U.S.Armed Forces?YesNoBranch of ServiceFromToType of Discharge Honorable General Medical Other Rank/Rate When DischargedDate of Discharge Training, duties and responsibilities in military servicePresent membership in any U.S. Military organizationHobbies & RecreationsName of relative in our employName of friend in our employWhat influenced you to apply at this companyHave you ever been convicted, pleaded guilty or pleaded nolo contendere to any felony or to any misdemeanor involving violence or dishonesty?YesNoIf yes, explain fully:Position DesiredStarting Salary ExpectedEmployment Planned:PermanentTemporaryPart timePreferred Starting DatePlease read carefully before submitting the form: I understand that the information given in this application will be treated as confidential. I certify that all statements and representations made in this application are true and correct and I have withheld nothing which would, if disclosed, adversely affect my application. I understand that the Association relies upon such statements in making its employment decisions, and I authorize the Association to investigate all such statements contained herein. I understand and agree that: any misrepresentation will be sufficient cause for cancellation of the application and/or for separation from the Association if such misrepresentation is discovered at any time after my employment by the Association. I further understand that applicants hired shall be on a ninety (90) day probationary period, but employment with the Association is always at will. I am aware that the use of this form does not indicate that there are any positions open, and does not in any way obligate the Association to employ me. I hereby authorize the Association to contact all employers specified in this application for the purpose of an employment reference, and I release all such persons and companies from any liability in responding to such requested information. In the event of my employment, I agree to abide by all rules and regulations of the Association. I understand that any offer of employment I am made is conditional on my passing a pre-employment physical [and drug test] prior to beginning work.* I hereby acknowledge that I have read and understood the above statements.
